Policy Governance & UM Analytics Lead - Remote

Humana Inc; Santa Fe (NM); Remote; USD 65,000 - 89,000; Full time

Job summary

Humana Inc. is seeking a Policy Governance Professional to support the Medicaid Utilization Management Policy Governance program.

Reporting to the Policy Governance Lead, you will manage end-to-end NCQA UM Rates and Timeliness evaluation and reporting across Medicaid markets, coordinating schedules, data validation, and stakeholder reviews. You will partner with operational, clinical, quality, compliance, and market teams; analyze trends; prepare summaries for committees; maintain audit-ready

Qualifications

• Bachelor’s degree required and healthcare industry experience a plus.
• Experience in operations, utilization management, quality, compliance, accreditation, reporting, governance, or related area.
• Proficiency with Microsoft Excel, PowerPoint, Word, SharePoint, and related collaboration/tracking tools.

Responsibilities

• Own and coordinate the end-to-end NCQA UM Rates and Timeliness Report process across applicable Medicaid markets and lines of business.
• Manage reporting calendars, milestones, stakeholder responsibilities, data collection, validation, approvals, and final deliverables.
• Partner with operational, analytical, clinical, quality, compliance, accreditation, and market teams to resolve data issues and report risks.
• Analyze results to identify trends, outliers, performance concerns, and opportunities for improvement.
• Coordinate, document, and monitor corrective or follow-up actions, escalating overdue or high-risk items as appropriate.
• Prepare reporting summaries and materials for review by Utilization Management Committees, leadership, and other governance bodies.
• Maintain complete, organized, and audit-ready documentation supporting reporting results, decisions, approvals, and committee oversight.
• Support broader Policy Governance activities, including committee operations, policy lifecycle processes, regulatory alignment, process documentation, and continuous improvement.
• The role also supports related policy governance, accreditation, compliance, and process-improvement activities.

Skills

Healthcare experience

Governance coordination

Education

Bachelor’s degree

Tools

Excel

PowerPoint

Word

SharePoint

Job description

Humana Inc. is seeking a Policy Governance Professional to support the Medicaid Utilization Management Policy Governance program.

Reporting to the Policy Governance Lead, you will manage end-to-end NCQA UM Rates and Timeliness evaluation and reporting across Medicaid markets, coordinating schedules, data validation, and stakeholder reviews. You will partner with operational, clinical, quality, compliance, and market teams; analyze trends; prepare summaries for committees; maintain audit-ready